Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Black men who have sex with other men have a higher estimated lifetime risk for HIV infection.

Note that the estimated lifetime risk of being diagnosed with HIV was 1.05%, meaning that approximately 3 million Americans will be diagnosed with HIV in their lifetime.

BOSTON -- Black men who have sex with other men have the highest estimated lifetime risk for HIV infection compared with other racial-ethnic groups, CDC researchers said here.

Based on an estimate of the lifetime risk of an HIV diagnosis for sex, age, and racial/ethnic subgroups, as well as by state, half of all black men who have sex with men will contract infection. Latino men who have sex with men also face a relatively high estimated lifetime risk (one in four), according to Kristen Hess, PhD, an Oak Ridge Institute for Science and Education (ORISE) fellow at the CDC in Atlanta, and colleagues.

Hess said that overall the lifetime risk for people in the U.S. has decreased from one in 78 to one in 99 when compared with similar studies using 2004-2005 data.

"Overall, the estimated lifetime risk of being diagnosed with HIV was 1.05%, meaning that approximately 3 million Americans ... will be diagnosed with HIV in their lifetime. This was a decrease from a 2004-2005 estimate (1.29%)," the authors wrote.

"However, vast disparities exist," Hess stated. "Blacks and Latinos have higher risks than whites, and men who have sex with men have a lifetime risk of one in six which is much higher than heterosexual men whose risk is one in 473.

"It was already known that these groups account for the largest proportion of HIV diagnoses, but presenting it in this manner may more effectively communicate the level of risk among these racial disparities to the general public, and could be a useful tool for clinicians, healthcare workers and social workers," Hess suggested.

She told MedPage Today that there may be issues "of discrimination and stigma" that make access to preventive services difficult.

Her group used the National HIV Surveillance System and other databases to perform the study, which is the first comprehensive national estimates of the lifetime risk of an HIV diagnosis for several key populations at risk and in every state, they said.

They looked at diagnoses and death rates from 2009-2013 to project the lifetime risk of HIV diagnosis in the U.S. by sex, race and ethnicity, state, and HIV risk group, assuming diagnoses rates remain constant. The researchers also determined that the lifetime risk of HIV infection is one in 20 for African-American men compared with a lifetime risk of one in 132 for white men.

The risk of HIV infection is one in 48 among African-American women compared with one in 880 for white women.

Women who inject drugs have a one in 23 lifetime risk of HIV infection compared with a rate of one in 36 for men who inject drugs.

The authors also found that living in the South increases the lifetime risk of HIV infection:

Washington, D.C.: one in 13

Maryland: one in 49

Georgia: one in 51

Florida: one in 54

Louisiana: one in 56

As shocking as the estimates are for certain segments of the population, the projections are not written in stone, commented Susan Buchbinder, MD, of the San Francisco Department of Public Health.

"What is being done here is to apply mathematical techniques to translate the data that we have about new infections into something that maybe will help communicate to providers, and perhaps the general population, about risk," she told MedPage Today.

But these lifetime risks are "not immutable," she cautioned. "We have lots of things we can do now ... hopefully for clinicians and all our programs, it pinpoints what we need to do -- engage people into prevention activities so their lifetime risk will go way, way down."

Buchbinder also called for more "aggressive" outreach to the most vulnerable populations.

"There is evidence that the rates of diagnosis in the minority communities are lower; the rate of people being offered antiretrovirals are lower; and the rates of viral suppression are lower," she explained. "There can also be other intervening factors, such as socioeconomic factors; access to care factors. The data suggest that African-American men who have sex with men get tested more frequently and have lower risk, and are still at increased risk of infection, and that probably has to do with sexual networks, and in some sense, stigma and discrimination. If you have a smaller network for choosing your sexual partner, HIV can spread more rapidly."

Hess and co-authors disclosed no relevant relationships with industry.

Buchbinder disclosed no relevant relationships with industry.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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